Association of body mass index on 10-year outcomes in patients treated with percutaneous coronary intervention and drug-eluting stents (the DECADE cooperation).

AIMS: To assess the association between body mass index (BMI) and 10-year clinical outcomes in patients undergoing percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation.

METHODS: This is a pooled analysis of five randomized trials with 10-year follow-up. All-cause death was the primary outcome. Secondary outcomes were cardiovascular death, myocardial infarction (MI), definite stent thrombosis (ST), and repeat revascularization.

RESULTS: A total of 9486 patients were analysed divided into four BMI groups (underweight [n = 92], normal-weight [n = 2785], overweight [n = 4296], and obese [n = 2313]). After 10 years, the risk of all-cause death was significantly higher in underweight patients than in those of normal weight (adjusted hazard ratio [HRadj], 1.58; 95% confidence interval [CI], 1.01-2.47). Compared with normal-weight patients, overweight patients had a significantly lower risk of all-cause death (HRadj, 0.84; 95% CI, 0.78-0.90) and cardiovascular death, while the difference was not significant for obese patients. Overweight and obese patients had a significantly higher risk of definite ST within 30 days, while obese patients had a significantly lower risk of TLR than normal-weight patients. There was a U-shaped, non-linear association between BMI, all-cause death, and cardiovascular death.

CONCLUSION: The baseline BMI of patients undergoing PCI with DES may have important implications for long-term secondary prevention strategies. Further dedicated studies are needed to overcome the limitations of the current analysis.